Common use of Written Agreements, Specific Requirements Clause in Contracts

Written Agreements, Specific Requirements. (A) Each of the Contractor’s Subcontracts shall contain the following: (1) Adequate information about the Grievance, Appeal, and State fair hearing procedures and timelines so that the Provider can comply with the Grievance and Appeals Systems requirements including: (i) The Enrollee’s right to a State Fair Hearing, how to obtain a hearing, and representation rules at a hearing; (ii) The Enrollee’s right to file Grievances and Appeals; (iii) The requirements and timeframes for filing a Grievance or Appeal; (iv) The availability of assistance in the filling process; (v) The toll-free numbers that the Enrollee can use to file a Grievance or Appeal by phone; (vi) The fact that, when requested by the Enrollee, disputed services will continue if the Enrollee files an Appeal or request a State fair hearing within the timeframes specified for filing, and the Enrollee may be required to pay the cost of disputed services furnished while the Appeal is pending if the final decision is adverse to the Enrollee; and (vii) Any State-determined Provider Appeal rights to challenge the failure of the Contractor to cover a service.